Treating ulcerative colitis

Treatment depends on how serious the condition is, with medication used for most people.  

Severe cases may need surgery to remove the entire colon, which is also the only cure for ulcerative colitis.

Management of ulcerative colitis involves treating the active flares of the disease, as well as attempting to ensure that it then remains in remission.

The mainstay treatment for active disease is steroids (cortisol).

Depending on the extent and severity of the disease, it may be given orally, rectally (enema) or as an intravenous injection.

Because steroids have side effects, they should only given for a short duration of time to induce remission. Side effects of steroids include weight gain, acne, facial hair, hypertension, mood swings and increased risk of infection. 

In addition, thinning of the bones (osteopenia/osteoporosis) is often associated with inflammatory bowel disease, and long-term steroid use aggravates this complication. That is why doctors are cautious when patients take these drugs and use them only when necessary.

Symptoms like severe bleeding and/or diarrhoea causing dehydration are occasionally so severe that a patient may need to be hospitalised.

Once the disease is in remission, drugs such as sulphasalazine, Asacol, Pentasa, azathioprine and methotrexate are effective in maintaining remission of the disease.

Asacol is available in both suppository and enema forms for those patients whose disease is limited to the end of the colon (the rectum and sigmoid colon). 

Possible side effects of these drugs include nausea, vomiting, heartburn, diarrhoea and headache.

Newer drugs for inflammatory bowel disease that have more targeted effects on the immune system are currently available. 

Immunosuppressive drugs (e.g. azathioprine and methotrexate) as well as biologically active drugs such as Revellex and Humira are now the preferred therapy for moderate to severe ulcerative colitis. 

Read more:

What is ulcerative colitis?

How can ulcerative colitis be treated?

How is ulcerative colitis diagnosed?

Reviewed by Dr Ismail Moola, MBCHB (UCT) FCP (SA) Cert Gastro Phys (SA). Specialist Physician / Gastroenterologist, Netcare Sunninghill Hospital; Lecturer, Department of Internal Medicine, Division of Gastroenterology, University of the Witwatersrand.

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